Jul 25, 2014

Clearing Cells to Prevent Cervical Cancer

Boston, MA - A study published online in
the International
Journal of Cancer
earlier this month describes a novel approach to preventing cervical cancer
based on findings showing successful reduction in the risk of cervical cancer
after removal of a discrete population of cells in the cervix.

The findings come from a study that
looked at squamocolumnar junction cells, or SCJ cells. These cells reside in
the cervical canal and have been implicated as the origins of cervical cancer.
A research team co-led by Christopher
Crum, MD, director, Brigham and Women's Hospital (BWH) Women's and Perinatal Pathology, demonstrated
that removal of SCJ cells resulted in a markedly lower risk of cervical
intraepithelial neoplasia-a non-cancerous, abnormal growth of cells on the
surface of the cervix that may progress to cervical cancer.

One hundred and thirty-one women with
cervical intraepithelial neoplasia were treated with a loop electrosurgical
excision procedure to remove the SCJ cells. During the follow-up period (of up
to four years), 16 recurrences were identified. Four were identified at the
first follow-up visit, and determined to be residual disease, meaning they were
not removed in the initial procedure. Twelve manifested after the first
postoperative visit and all were in the ectocervix or in mature metaplastic
epithelium. All of the 12 delayed recurrences were cervical intraepithelial
neoplasias and did not have SCJ cells.

"We have always suspected that most
recurrences following apparently successful therapy do not develop in the same
location as the original precancer, which was at the squamocolumnar junction,"
said Crum. "Moreover, studies in the literature have shown that the risk of a
significant precancer following successful removal is quite low. Our study is
in sync with these observations and suggests that removing SCJ cells might have
a significant impact in reducing the risk of cervical cancer."

Crum emphasizes that eliminating SCJ
cells does not prevent cervical intraepithelial neoplasias nor does it prevent
human papilloma virus (HPV) infection-which can lead to cervical cancer. But
what is significant about the findings, according to the researchers, is that
removal of SCJ cells seems to alter recurrence patterns, presumably by removing
the population that is most vulnerable to development of the more dangerous
precancers.

"This is a concept that is in great need
of a controlled clinical trial aimed at prevention rather than treatment," said
Crum. "It would give us important insights into whether preemptive removal of
the SCJ region would have the desired effect."

An accompanying editorial, by Silvia
Franceschi, MD, International Agency for Research on Cancer, suggests
continuation of the work by "careful evaluation of the impact of prophylactic
ablation in the framework of large screening programmes."

This study was supported by the Belgian Fund for Medical Scientific Research, Centre Anti-Cancereux près l'Université de Liège, Faculty of Medicine of the University of Liège, National Cancer Institute (1R21CA173190-01), and Fonds Léon Frédéricq.